Individual
LYDIA SHAMOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6777 W MAPLE RD, WEST BLOOMFIELD, MI 48322-3013
(248) 325-1000
Mailing address
1339 AZALEA LN, WATERFORD, MI 48327-4413
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10134526500
HAP
MI
Enumeration date
03/19/2021
Last updated
02/16/2022
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